Physiologic predictors of postoperative abscess in children with perforated appendicitis: Subset analysis from a prospective randomized trial

• Published in: Surgery Vol. 147; no. 5; pp. 729 - 732
• Main Authors: Fraser, Jason D., MD, Aguayo, Pablo, MD, Sharp, Susan W., PhD, Snyder, Charles L., MD, Holcomb, George W., MD, MBA, Ostlie, Daniel J., MD, St. Peter, Shawn D., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2010; Elsevier
• Subjects: Abdominal Abscess - diagnosis; Abdominal Abscess - epidemiology; Abdominal Abscess - prevention & control; Age Distribution; Anti-Bacterial Agents - therapeutic use; Appendicitis - diagnosis; Appendicitis - drug therapy; Appendicitis - epidemiology; Appendicitis - surgery; Biological and medical sciences; Body Mass Index; Child; Combined Modality Therapy; Databases, Factual; Female; Fever - epidemiology; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Male; Medical sciences; Other diseases. Semiology; Predictive Value of Tests; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Surgical Wound Infection - diagnosis; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; Human; Postoperative; Appendicitis; Abscess; Prediction; Medicine; Prospective; Randomization; Treatment; Surgery; Digestive diseases; Intestinal disease; Clinical trial; Predictive factor; Child
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2009.10.057

Background Intra-abdominal abscess after appendectomy is the most common complication in patients with perforated appendicitis. There are currently little data that may forecast which patients are more likely to develop an abscess. Therefore, we performed a retrospective analysis of a prospectively collected dataset to determine whether there are predictors for developing a postoperative abscess. Methods The dataset was collected prospectively in a randomized trial comparing antibiotic regimens in 98 pediatric patients with perforated appendicitis. All patients underwent laparoscopic appendectomy and received a minimum of 5 days of intravenous antibiotics. The Pearson correlation was used to evaluate the influence of patient, intra-operative, and early postoperative variables on the development of an abscess. Two-tailed P values were determined from the correlation coefficient, and significance was defined as P ≤ .05. Results At presentation, a positive correlation for abscess formation was identified with increasing age ( P = .003), weight ( P = .001), body mass index ( P = .008), and diarrhea ( P = .005). Operative time had no influence on abscess development. After operation, there was progressively increasing positive correlation between abscess and the maximum temperature each successive postoperative day. This relationship became significant at day 3. An increased white blood cell count on day 5 was highly predictive of abscess ( P < .001). Conclusion In children presenting with perforated appendicitis, increasing age, weight, and/or body mass index correlated with the development of a postoperative abscess. Diarrhea on presentation also poses an increased risk of abscess. Postoperatively, each successive day with a fever is incrementally more predictive of an abscess formation.